DHB 2006/07 - Health Systems Trust

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Section A: Indicator Comparisons by District 4.2 Caesarean Section Rate Peter Barron The Caesarean section rate measures the proportion of deliveries in which a Caesarean section was performed. This is a facility-based indicator and not a population-based indicator. In other words it uses deliveries that take place in a facility (clinic, health centre or district hospital) as the denominator as opposed to using all deliveries (both facility and home deliveries) as the denominator. The numerator is the number of Caesarean section operations done in district hospitals. District View In 2006/07 the national average for district hospitals in South Africa was 14.7%. This excluded any Caesarean section operations done in level 2, 3 and 4 hospitals. In 2005/06 the national average for district hospitals was 13.7% with a total for all hospitals of 18.4%. As can be seen in Map 10 and Figure 53 there was a wide variation in the Caesarean section rates among the 52 districts in 2006/07. At the top end of the scale was the City of Cape Town (WC) with a rate of 30.6% whilst at the low end was Siyanda (NC) with 1.3%. There are no district hospitals in Metsweding (GP) resulting in no data for this district. In addition, the missing data from Amajuba and Xhariep districts suggest that no Caesarean sections took place in these districts or that there was a problem in collecting these data in 2006/07 as there were some data available in 2005/06. Five of the ten districts with the highest Caesarean section rates were in KwaZulu-Natal. Probably the high HIV prevalence rates in this province contributed to these high rates, but it is likely that different districts and different provinces followed different protocols and guidelines in regard to Caesarean sections and it would be useful for specific health systems research to be done to unpack the reasons for these large differences. There were nine districts with Caesarean section rates over 20% and eleven districts (excluding Amajuba and Xhariep) with Caesarean section rates under 10%. Caesarean sections are one of the components of essential obstetric care (EOC) and such wide differences are indicative of very different levels in the quality of obstetric care around the country. There were also wide variations between districts in the same province in 2006/07. A Caesarean section is one of the most basic operations and should be performed in every hospital. It is therefore likely that sub-optimal care is being delivered in some districts (i.e. those with low Caesarean section rates) and over-treatment, with unnecessary complications of the operation, in some districts (i.e. those with high Caesarean section rates). The current national target of 11% is clearly not an accurate reflection of what the reality is or should be. It probably needs a panel of experts to review this target in order to develop a more appropriate guideline. There were five districts with Caesarean Section rates of 5% or less. These districts either contained district hospitals which were incorrectly classified (i.e. they are in reality community health centres) or they were not functioning adequately with low quality of obstetric care. In either event they need managerial investigation. THE DHIS INDICATORS PRESENTED HERE ARE AS RECEIVED FROM THE NATIONAL DHIS AND HAVE NOT BEEN ALTERED BY THE AUTHORS OR HST 57
Section A: Indicator Comparisons by District Map 10: Caesarean section rate in South Africa, 2006/07 Caesarean section rate, 2006/07 Legend CS_06 no data / no hospitals under 10 % 10 - 14 % 15 - 19 % 20 - 24 % 25 % and above 58 THE DHIS INDICATORS PRESENTED HERE ARE AS RECEIVED FROM THE NATIONAL DHIS AND HAVE NOT BEEN ALTERED BY THE AUTHORS OR HST
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Foreword The District Health Barome
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Variables included in the analysis
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Appendices Appendix 2 Deprivation I
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Appendices Interpreting negative an
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Appendices Appendix 4: Indicator De
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Appendices Group ``Type Level Indic
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DHB 2006/07 - Health Systems Trust

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